Transjugular Tricuspid Valve Edge-to-Edge Repair

Figures

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  Figure 1. Three-Dimensional Computed Tomography Reconstruction

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  Figure 2. Fluoroscopic Image After Conversion to the Right Internal Jugular Approach, Showing Improved Trajectory and More Favorable Alignment of the Delivery System Toward the Anterior-Septal Coaptation Line

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  Figure 3. Transfemoral vs Transjugular Transcatheter Tricuspid Valve Edge-to-Edge Repair: Anatomic Trajectory and Maneuver Differences (A) Patient-specific 3-dimensional reconstruction showing the transfemoral trajectory from the inferior vena cava (IVC) to the right atrium (RA), limited by the prominent Eustachian ridge. (B) Patient-specific 3-dimensional reconstruction showing the transjugular trajectory from the superior vena cava (SVC) to the RA, providing a more favorable path to the tricuspid valve. The table summarizes key maneuver differences between transfemoral and transjugular transcatheter tricuspid valve edge-to-edge repair. Because the delivery system is effectively inverted from the jugular approach relative to transfemoral delivery, several maneuvers generate opposite directional effects. Maneuvers not shown in the table—retracting the stabilizer, counterclockwise rotation of the steerable guide catheter, “−” of the steerable guide catheter, “L” knob, and “E” knob—produce the opposite effects of their corresponding maneuvers listed above. AS = anteroseptal; IVC = inferior vena cava; PS = posteroseptal; RA = right atrium; RV = right ventricle; SGC = steerable guide catheter;…

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  Visual Summary. Transjugular Tricuspid Valve Edge-to-Edge Repair in the Setting of a Prominent Eustachian Ridge (A) Preprocedural cardiac computed tomography showing the prominent Eustachian ridge. (B) Three-dimensional computed tomography reconstruction demonstrating the prominent Eustachian ridge. (C) Intraprocedural transesophageal echocardiography demonstrating the prominent Eustachian ridge and severe tricuspid regurgitation. (D) Fluoroscopic image after conversion to the right internal jugular approach. (E) Final intraprocedural transesophageal echocardiography demonstrating reduction of tricuspid regurgitation from torrential to mild. Red arrows indicate the prominent Eustachian ridge.